Sarcoidosis is a multisystem disease which may present with non-specific symptoms or symptoms related to organ-specific involvement.
Non-specific symptoms include fever, malaise, fatigue and weight loss.
Pulmonary involvement is seen in >90% of sarcoidosis patients.

Adequate tests for presence of ongoing infection (eg latent tuberculosis) should be done prior to initiation of treatment

Tumor Necrosis Factor-Alpha (TNF-alpha) Inhibitors

Eg Infliximab, Adalimumab

Evidence to support Adalimumab’s efficacy for pulmonary chronic sarcoidosis are limited

Infliximab is used as an alternative pulmonary & extrapulmonary sarcoidosis therapy for patients refractory to corticosteroids

Studies show that Infliximab is an effective TNF-alpha inhibitor not only against pulmonary, but also for other types of sarcoidosis (ie skin, kidney, muscle, bone), & for patients w/ hypercalcemia, neuropathy & disabling fatigue

Etanercept

Further studies are needed to prove the efficacy of Etanercept therapy against sarcoidosis

Pentoxifylline

Studies show that patients w/ acute pulmonary sarcoidosis respond well to Pentoxifylline

Thalidomide

Studies proving the efficacy of Thalidomide for pulmonary sarcoidosis is lacking

Anti-malarial Agents

Chloroquine & Hydroxychloroquine

Action: May inhibit macrophage production of TNF-α

Efficacy for the treatment of chronic sarcoidosis has been established

Effect on disease activity is more likely suppressive than curative

Chloroquine has been shown to be particularly helpful in hypercalcemia & lupus pernio

Hydroxychloroquine is usually preferred because of lower risk of ocular toxicity

New treatments such as pirfenidone and nintedanib slow lung function decline and progression of idiopathic pulmonary fibrosis (IPF), although response to treatment can vary dramatically among patients, according to a presentation at the 21st Congress of the Asian Pacific Society of Respirology (APSR 2016) held in Bangkok, Thailand.